Does Coping Matter? Study Challenges Medical Value of CBT and GET

Editor's Comment: This empirical study tested the theory that coping strategies (Self-Distraction, Active Coping, Behavioral Disengagement, Planning, Acceptance, and Self-Blame) lead to an improvement in health among people with CFS/ME. Coping strategies are an integral part of Cognitive Behavioral Therapy (CBT), whose proponents maintain that teaching individuals with CFS/ME how to better cope with their illness will lead to better health outcomes. The findings of this study suggest that "adaptive coping strategies were not associated with improved health." Further, the researchers found that in regard to Graded Exercise Therapy (GET) "the general pattern of results does not suggest that pushing beyond one’s limits would be beneficial with regards to symptomatology or functionality." The results of this study directly challenge the claims made in the January 2013 White et al. study, "Recovery from chronic fatigue syndrome after treatments given in the PACE trial."

Note: A PDF file of the full paper can be requested from Abigail Brown at: abrown57@depaul.edu

Objective/Hypothesis: The objective of this study was to examine sub-types of individuals with chronic fatigue syndrome based on variables that are associated with the energy envelope theory and to examine the role of coping strategies in explaining the differences found between the subtypes.

Methods: Cluster analysis was used. Grouping variables included physical functioning, post-exertional malaise severity, and the extent to which an individual was outside of the energy envelope. These clusters were evaluated using discriminant function analysis to determine whether they could be differentiated based on coping styles.

Results: Cluster analysis identified three groups. Clusters 1 and 2 were consistent with the energy envelope theory. However, Cluster 3 was characterized by patients with the most impairment, but they were to a lesser extent exceeding their energy envelope. Coping strategies explained a small percentage (10%) of the variance in differentiating the clusters.

Discussion: Energy maintenance may be associated with improved functioning and less severe symptoms for some. However, patients in Cluster 3 were closer to remaining within their energy envelope and also used higher levels of adaptive coping but were more impaired than Cluster 2. This suggests that adaptive coping strategies were not associated with improved health, as members of Cluster 3 were severely limited in functioning.

CBT helped me with the initial transition to life with chronic illness, but it has not improved the illness medically, just my response to it. After 15 years, it's still a daily challenge with no medically relevant improvement.